Open Access Research

Adjuvant chemoradiotherapy for locoregionally advanced and high-risk salivary gland malignancies

Aaron W Pederson1, Joseph K Salama2, Daniel J Haraf34, Mary Ellen Witt3, Kerstin M Stenson45, Louis Portugal45, Tanguy Seiwert46, Victoria M Villaflor46, Ezra EW Cohen46, Everett E Vokes346 and Elizabeth A Blair45*

Author Affiliations

1 Department of Radiation Oncology, Memorial University Medical Center, 4700 Waters Avenue, Savannah, GA 31404, USA

2 Department of Radiation Oncology, Duke University School of Medicine, Box 3085 Durham, NC, 27710, USA

3 Department of Radiation and Cellular Oncology, University of Chicago, 5758 S. Maryland Ave, MC 9006, Chicago, IL 606037, USA

4 Comprehensive Cancer Center, University of Chicago, 5841 S Maryland Ave, Chicago, IL, USA

5 Section of Otolaryngology/Head and Neck Surgery, Department of Surgery, University of Chicago 5841 S. Maryland Ave, MC 1035, Chicago, IL, USA

6 Section of Hematology/Oncology, Department of Medicine University of Chicago, 5841 S. Maryland Ave, MC 2115, Chicago, IL, 60637, USA

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Head & Neck Oncology 2011, 3:31  doi:10.1186/1758-3284-3-31

Published: 26 July 2011

Abstract

Background

To report the outcomes of patients with locoregionally advanced and high- risk salivary gland malignancies treated with surgery followed by adjuvant chemoradiotherapy.

Methods

From 09/1991 - 06/2007, 24 high-risk salivary gland cancer patients were treated with surgery, followed by adjuvant chemoradiotherapy for high-risk pathologic features including, perineural involvement, nodal involvement, positive margins, or T3/T4 tumors. Chemoradiotherapy was delivered for 4-6 alternating week cycles: the most common regimen, TFHX, consisted of 5 days paclitaxel (100 mg/m2 on d1), infusional 5-fluorouracil (600 mg/m2/d × 5d), hydroxyurea (500 mg PO BID), and 1.5 Gy twice daily irradiation followed by a 9-day break without treatment.

Results

Median follow-up was 42 months. The parotid gland was more frequently involved (n = 17) than minor (n = 4) or submandibular (n = 3) glands. The median radiation dose was 65 Gy (range 55-68 Gy). Acute treatment related toxicity included 46% grade 3 mucositis and 33% grade 3 hematologic toxicity. Six patients required feeding tubes during treatment. One patient progressed locally, 8 patients progressed distantly, and none progressed regionally. Five-year locoregional progression free survival was 96%. The 3 and 5 year overall survival was 79% and 59%, respectively. Long-term complications included persistent xerostomia (n = 5), esophageal stricture requiring dilatation (n = 1), and tempromandibular joint syndrome (n = 1).

Conclusions

Surgical resection followed by adjuvant chemoradiotherapy results in promising locoregional control for high-risk salivary malignancy patients.